Calling healthcare a “basic human right” may make an advocate feel more politically virtuous and caring. Nevertheless, the phrase oversimplifies and stunts the necessary debate remaining over how our healthcare system should and could operate better.
The rights-based approach to healthcare reform remains wrong as a matter of U.S. law, history, politics and economics. We can do better than just recycle another round of these empty words.
Below, I show a reasonable projection of the share of national income that will have to be spent paying for these obligations in the future if there is no substantial restructuring of liabilities. It’s based on consensus forecasts from groups such as the Congressional Budget Office and the Office of Management and Budget for economic growth and for programs such as Social Security and Medicare where such forecasts are available—but in some cases, such as state debts and pensions, no such forecast was available, and so I developed a simple one.
Editor’s note: the graph rises from roughly 3% of GDP in 1950 to nearly 20% of GDP by 2040.
The government of a country with a good financial reputation could borrow from the international capital market and use the proceeds to endow a sovereign wealth fund that mainly invests in the world stock market. In expectation, this country would gain the equity risk premium multiplied by the size of the fund. This gain could be earmarked to a social dividend. This paper deals with the conditions under which such a policy is welfare‐improving, discusses the optimal size of such a fund, and proposes an institutional framework for the management of public stock ownership.
This article reviews the basic theoretical models that are appropriate for analyzing different types of welfare reforms, as well as the related empirical literature. We first present the canonical labor supply model of a classical welfare program and then extend this basic framework to include in-kind transfers, incomplete take-up, human capital, preference persistence, and borrowing and saving. The empirical literature on these models is presented. The negative income tax, earnings subsidies, US welfare reforms with features that differ from those in other countries, and childcare reforms are then surveyed in terms of both the theoretical models and the empirical literature surrounding each.
Americans joke that college students have so little money that they subsist on 10 cent packs of ramen. Statistically, college students face much higher rates of food insecurity than the general population and the situation is particularly dire for students of color. Much has been written on this area in recent months and years and many commentators are seeking to denormalize poverty, hunger, and the “freshman 15” on campuses. This article will look to a solution for this hungry and often neglected population. In 2010, the Health, Hunger-Free Kids Act (HHFKA) reauthorized the Federal School Lunch Program. HHFKA contained several innovations, however, one that is particularly relevant is the “identified students” provision. Under this scheme, students whose families already receive Supplemental Nutrition Assistance Program (SNAP) benefits, Medicaid, or are enrolled in several other federal assistance programs qualify for free or reduced-price school meals without a separate application. With the next iteration of the Farm Bill, SNAP should be adjusted to similarly accommodate low income college students. Under this new program, students who qualify for Perkins Loans, Federal Work Study, Pell Grants, Federal Supplemental Educational Opportunity Grants, and similar federal programs would also receive SNAP benefits without an additional application. The benefits to such a program would be tremendous. In many states, college students are specifically excluded from receiving benefits such as SNAP and Medicaid. This policy change would move students away from food insecurity, reduce the burden of schools providing high quality dining experiences that are a major contributor to the cost of higher education, reduce student debt, and bring the political capital of university students to SNAP.
Hashing it Out: Blockchain as a Solution for Medicare Improper Payments by William J. Blackford :: SSRNSeptember 18, 2018
Part I highlights the inadequacies and inefficiencies of our Medicare payment system, focusing on the initiatives currently in place and the susceptibilities that persist. Part II offers a broad overview of the development, importance, features, and collateral technologies surrounding blockchain. Part III posits that Congress and HHS, through its various subsidiary agencies, should work in tandem with private stakeholders to create and/or implement a blockchain-based infrastructure to facilitate federal healthcare payments and support future growth of quality-based initiatives. This Note concludes with a recommendation for future agency research focusing on the viability and cost efficiency of a blockchain solution.
This project explores the causes behind the recent decline in the Labor Force Participation (LFP) rate. The analysis examines the evolution of the LFP rate for different demographic groups to gauge the effect of demographic changes. An integral part of the project is an investigation of the flows of workers into and out of the labor force to determine whether the LFP rate has been declining because more workers are leaving or because fewer workers are entering the labor market. The project also studies the evolution of wages and finds that the decline in the LFP rate is often accompanied by a declining real wage, which is indicative of the relative importance of demand versus supply factors.
We study the aggregate consequences of the Social Security Disability Insurance (DI) program, focusing on the role of complementarity between heterogeneous human capital. First, we develop and estimate a wage process in which individuals’ human capital is composed of (pure) labor and work experience, and the two inputs are (differentially) affected by disability. We find that older workers are more experience-abundant and that disability causes a smaller loss in experience than it does in labor. Based on the estimates, labor and experience are complementary inputs in aggregate production. Combining these results with a structural general equilibrium model, we conduct quantitative analyses and find that the removal of DI increases the relative supply of experience, as more old individuals work. This compositional change in labor and experience lowers the labor productivity (despite higher employment and output) in the economy without DI, due to the complementarity between the two inputs.
EBRI Retirement Security Projection Model®(RSPM) – Analyzing Policy and Design Proposals by Jack VanDerhei :: SSRNSeptember 15, 2018
At various times, policymakers have sought to improve the defined-contribution system by increasing the number of workers who have access to the system and by seeking ways to keep money in the system until workers retire. Conversely, motivated by budget concerns, they have also sought to reduce tax deferrals from the system by limiting pretax contributions through caps and other mechanisms.
Such policymaking can lead to unintended, and undesirable, consequences if it is not informed by sound research. The Employee Benefit Research Institute (EBRI) originally developed its Retirement Security Project Model® (RSPM) with the goal of providing just such insight for policymakers. Using assumptions based on actual, anonymized administrative data from tens of millions of 401(k) participants, RSPM® has been used to simulate the percentage of the population at risk of not having retirement income adequate to cover projected expenses under the current system since 2003. More critically, it can be used to examine the impact of potential changes to the 401(k) system — such as those proposed by policymakers.
In this Issue Brief, we will examine the impact of various retirement-reform proposals on all US households between the ages of 35 and 64 by first assessing the current, aggregate national-retirement deficit, and then examining the impact of the following potential initiatives:
– Auto Individual Retirement Account (IRA) programs, such as the one proposed under President Obama’s 2015 Budget.
– Programs expanding access to defined contribution plans, such as the Automatic Retirement Plan Act of 2017 (ARPA) proposal.
– A universal defined-contribution scenario.
– Auto-portability proposals.
– Proposed reductions in the 402(g) and/or 415(c) limits.
Note: RSPM® incorporates a definition of retirement income adequacy that is far more comprehensive than most models today. In RSPM®, a household is considered to “run short of money,” or to experience a retirement savings shortfall, if its resources in retirement are not sufficient to meet average deterministic retirement expenditures plus uncovered long-term care expenses from nursing homes and home health care.
Key findings from this RSPM® analysis are:
– It is projected that 57.4 percent of all US households – including those covered by employer-sponsored retirement plans and those who are not – will achieve retirement success and will not run short of money in retirement. But that means that nearly 43 percent of households will not achieve retirement success according to the model, though some may fall short by relative small amounts.
– However the probability of a successful retirement depends to a great extent on whether employees are eligible to participate in a defined contribution (DC) plan. For example, among Gen Xers, those with no future years of eligibility are simulated to have only a 48 percent probability of not running short of money in retirement. In contrast, those who have 20 or more years of future eligibility (this may include years in which employees are eligible but choose not to participate) are simulated to have a 72 percent probability of achieving a successful retirement and not running short of money.
– This translates into an aggregate national retirement savings shortfall of $4.1 trillion. The deficit averages nearly $90,000 for workers ages 35-39 who currently do not have and are not projected to gain access to the defined-contribution system. In contrast, for those fortunate enough to spend much of their working lives eligible for participation in the defined-contribution system, the projected deficit is less than a quarter of that amount.
– Long-term care costs must be considered if an accurate picture of retirement income adequacy is to be gained. Failing to incorporate long-term care costs into the model significantly changes the probability of not running short of money in retirement — increasing it by nearly a quarter.
– Various reform scenarios could reduce the retirement deficit by as much as 802 billion, or 19.4 percent.
– Eliminating pre-retirement cashouts would enable an additional 20 percent of low-income workers currently ages 25–29 who will have more than 30 years of simulated eligibility for participation in a 401(k) plan to attain an 80 percent real replacement rate from Social Security, 401(k) plan balances and IRA rollover balances that originated in 401(k) plans. It should be noted, however, that these results do not consider any potential reduction in contributions on behalf of workers who might, knowing that monies would not be available for hardship situations, decide to reduce, or even cease contributing to these plans.
– Reducing current contribution limits could significantly reduce projected account balances for certain workers
Social Security Retirement Benefits: A Timing Model for Working Families by Francine J. Lipman, James E. Williamson :: SSRNSeptember 15, 2018
With more than 61 million individuals receiving Social Security benefits, one out of every four families in America receives monthly cash payments from the Social Security Administration (SSA). These monthly payments directly benefit 48.5 million retired workers, their current and former spouses, 10 million disabled adults, and include more than 3 million children. Several million more children and adults in the increasing number of multi-generational households in America benefit indirectly from Social Security retirement payments.
In addition to the broad reach of monthly Social Security retirement benefits these payments have ensured the financial well-being of millions of American families for more than 80 years. Eight-four percent of Americans 65 and older receive benefits with more than 60 percent of Social Security beneficiaries receiving one-half or more of their income from SSA. Notably, 33 percent of all beneficiaries receive at least 90 percent of their income from SSA. The percentages of people of color who rely on Social Security income are even more significant. Hispanic, Black, and Asian seniors rely on Social Security benefits for one-half or more of their income at rates of 73, 69 and 62 percent, respectively. Similarly, Hispanic, Black, and Asian seniors rely on Social Security benefits for 90 percent or more of their income at rates of 52, 45, and 41 percent, respectively. Additionally, about 48 percent of married couples, and 71 percent of unmarried individuals, receive one-half or more of their income from SSA. After decades of decreases in defined benefit plans and interest rates, and escalating health care costs and life spans, these high rates of reliance on Social Security benefits are not surprising. Given the depth and breadth of reliance on Social Security benefits it is critical for households to understand and plan for decreasing average retirement benefit amounts. Seniors rely on Social Security retirement benefits because many have few or no other resources. According to the General Accounting Office, 41 percent of households age 55 and older; 52 percent of households age 65 through age 74; and 71 percent of households age 75 and older have no retirement savings. Therefore, maximizing Social Security retirement benefits is critical for seniors’ and their families’ health, safety, and welfare. As of June 2017, retired workers received average yearly benefits of $16,428, while surviving spouses aged 60 or older only received $15,684 of average yearly benefits. Retired workers and their spouses had average yearly aggregate benefits of $27,336, and a widowed senior with two dependent children received average yearly benefits of $31,968 for the household. These amounts represent current average earnings replacement rates of only 52, 38, 32, and 25 percent of low ($22,215), medium ($49,366), high ($78,985) and the maximum ($120,418) earnings amounts for a retired worker at age 65 in 2017. Over time these replacement rates are scheduled to decrease as full retirement age (FRA) increases. Medium earners’ replacement rates at age 65 will decrease from 38 to 34 and 31 percent in 2020 and 2030, respectively.
Because Social Security benefits are such an important component of household income for families, it is not surprising that in 2016 Social Security benefits lifted more than 26 million people out of poverty including 1.5 million children, 7.5 million adults and more than 17 million seniors. Moreover, Social Security benefits decreased the depth of and proximity to poverty for millions more seniors, children, and their families.
The amount of monthly Social Security retirement benefits a senior and her family receives is directly related to when they are claimed. Accordingly, the timing of claiming Social Security retirement benefits is a vital decision for individuals who rely on their benefits to support their households. Many decision models and measures being used by individuals to analyze this timing decision, among other individual financial decisions, are the same measures that have been developed to guide large business organizations. However, because of differences in economic size, capacity, life cycle, mission, goals, and unique human attributes, these large organization models do not fit the needs of lower and middle-income households. At the same time, these increasingly vulnerable individuals do need strategic measures to focus on when making financial decisions. Strategic measures specifically designed to meet the unique needs of these individuals could be valuable to their families and the economy at large as benefits are decreasing over time. One such approach is to analyze, determine, and measure the quality-value of marginal Social Security benefits to a household. This Article will present a few exemplary quality-value dollar timing models. The quality-value dollar models better expose financial advantages that seniors gain by delaying their retirement benefits.
As members of Congress struggle to resolve the long-term financial viability of Social Security and Medicare given an aging and longer-living U.S. population, it is possible that increasing FRA beyond age 67 may be part of any reform package. A quality-value dollar model would be instructive in senior outreach, education, and engagement regarding Social Security benefits timing decisions and any other changes to the existing Social Security retirement system.
Keywords: Social Security retirement income, low-income seniors, anti-poverty, retirement benefits, elder law, adequacy of retirement income, retirement income security, Social Security spousal benefits